International Journal of Research in Orthopaedics Kshirsagar J et al. Int J Res Orthop. 2024 Nov;10(6):1364-1369 http://www.ijoro.org
DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20243136
Case Series
Impact of ayurvedic panchakarma therapy on osteoarthritis
Jyoti Kshirsagar1*, Asha Lakariya1, Sadik Khan2
1Madhavbaug Cardiac Clinic, Aundh, Pune, Maharashtra, India 2Madhavbaug Cardiac Clinic, Maninagar, Ahmedabad, Gujrat, India Received: 03 September 2024 Revised: 08 October 2024 Accepted: 12 October 2024 *Correspondence: Dr. Jyoti Kshirsagar, E-mail: jyotikshirsagar78@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT Osteoarthritis is the leading cause of chronic pain and disability in adults, imparting a substantial economic burden on both society and individuals. This case series explored the impact of Ayurvedic Panchakarma therapy on knee osteoarthritis. Data from procedures conducted between March 2022 and January 2024 at a clinic in Maharashtra, India was collected. Patients of either gender who were clinically diagnosed with osteoarthritis grade 2 and underwent Knee Rejuvenation Therapy were included in this analysis. Follow-up was conducted after 1 month and at 90 days. Baseline data was compared with follow-up data. A total of 16 patients with mean age of 57.63 ± 10.20 years were included in the study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) score (day 1: 20.31±11.18, after 1 month: 49.94±10.85, day 90: 71.31±5.89, p=0.00), pain (day 1: 25.44±14.03, after 1 month: 57.81±10.66, day 90: 80.63±5.78, p=0.00), symptoms (day 1: 30.69±14.59, after 1 month: 55.75±12.94, day 90: 83.00±6.04, p=0.00), sports (day 1: 2.81±6.84, after 1 month: 25.31±15.05, day 90: 39.69±15.76, p=0.00), function (day 1: 31.25±16.69, after 1 month: 58.94±12.34, day 90: 78.81±7.98, p=0.00), and quality of life (day 1: 14.13±14.83, after 1 month: 52.00±10.78, after 1 month: 73.50±4.50, p=0.00) increased from baseline to the 90-day follow-up. Ayurvedic treatment is effective in improving the KOOS score and reducing the severity of arthritis in diagnosed osteoarthritis patients. Keywords: Ayurveda, Exercise, Knee osteoarthritis, KOOS score, Pain relief
INTRODUCTION
Osteoarthritis is a chronic, degenerative, and progressive disorder and is the most predominant type of musculoskeletal disorder worldwide.1 It is characterized by loss of articular cartilage, bone hypertrophy at the margins, subchondral sclerosis, and biochemical and morphological alterations of the synovial membrane and joint capsule.
Symptoms include pain, especially after prolonged activity and/or weight bearing. If inactive for too long, stiffness may occur. The estimated prevalence in India is 22–39%.2 Knee osteoarthritis is among the most prevalent osteoarthritis. Treatment of knee osteoarthritis includes medications, conservative and operative treatment. Therapeutic drugs such as non-steroidal anti-
inflammatory, and analgesics have gastrointestinal, renal, and cardiovascular side effects.3 Complementary and alternate therapies are widely accepted in India, and incorporating evidence-based practices from these alternative therapies can be beneficial in the management of osteoarthritis.
Current guidelines advocate for the inclusion of physiotherapy and rehabilitative measures as effective strategies for managing osteoarthritis in the knee and other joints of the body.1 Ayurveda is a traditional medicine with wide acceptance in India. It employs treatment approaches such as manual therapies, lifestyle changes, nutritional advice, medication, yoga, and purification techniques. However, evidence assessing these treatment approaches are scarce.4 Against this background the present case series was designed to explore the role of therapeutic exercise as
International Journal of Research in Orthopaedics | November-December 2024 | Vol 10 | Issue 6 Page 1364
Kshirsagar J et al. Int J Res Orthop. 2024 Nov;10(6):1364-1369
intervention in managing pain associated with knee osteoarthritis.
CASE SERIES
Data from procedures conducted between March 2022 and January 2024 at a clinic in Maharashtra, India was collected. Patients of either gender who were clinically diagnosed with osteoarthritis grade 2 and underwent Knee Rejuvenation Therapy were included in this analysis. All patients provided written informed consent for then collection and analysis of the data for research purposes.
Knee rejuvenation therapy
The first step was centripetal oleation with Vatari oil (Nirgundi Dashmula) and Murchit oil (Til oil) for 20–25 mins twice weekly. Nirgundi oil has anti-inflammatory and anti-arthritic properties. It relieves pain and edema, promotes hair growth, cleanses wounds, and promotes healing. This step is performed twice weekly. The second step was Janu Basti procedure to both knee joints. The tense machine was used for 10 mins, Janu Basti with Vatari oil was administered for 30 mins and Nadi Swed with Dashmool decoction was administered for 7–10 mins.
Janu Basti relieves pain and inflammation, increases blood circulation, and strengthens and nourishes the knee joints. It also relieves stiffness by lubrication of the knee joint and maintaining synovial fluid levels. This step was performed twice weekly. The third step was Shalishasti pinda sweda with a combination of Shalishasti rice and Balya Bharad to soften the skin, dilate the blood vessels, improve peripheral circulation, reduce congestion, excrete metabolic waste and toxins through sweat and reduce edema. It lasted for 20–25 mins. Thermal vasodilation with Dashmula decoction for 10–15 mins was also administered. This step was performed twice weekly. The last step was per rectal herb decoction administration (Basti). The first oil used was Mat B (Vatex oil) for 5–10 mins which was useful in neuo-muscular disorders due to its anti-inflammatory, analgesic, and diuretic properties. The second oil used was a combination of Panch Tikta Bharad, Panch Tikta Ghrut, and Murchit til oil for 5–10 mins. This was useful in Kapha disease, skin diseases, and neuro-muscular disorders. The last oil used was Sahachar oil. This oil has anti-inflammatory and analgesic properties and improves blood circulation and eliminates metabolic waste. This step was also performed twice weekly. The treatment plan is outlined in Table 1. Low calorie low carb protein rich vegetarian diet plan was followed by patients.
Table 1: Knee rejuvenation therapy.
International Journal of Research in Orthopaedics | November-December 2024 | Vol 10 | Issue 6 Page 1365
Kshirsagar J et al. Int J Res Orthop. 2024 Nov;10(6):1364-1369
Table 2: Demographics of study patients.
All data are expressed as mean±standard deviation.
Table 3: Patient outcomes.
All data are expressed as mean±standard deviation.
Table 4: KOOS score and pain according to gender and knee arthritis grade.
All data are expressed as mean±standard deviation.
International Journal of Research in Orthopaedics | November-December 2024 | Vol 10 | Issue 6 Page 1366
Kshirsagar J et al. Int J Res Orthop. 2024 Nov;10(6):1364-1369
Table 5: Average function/daily living and quality of life according to gender and knee arthritis grade.
All data are expressed as mean ± standard deviation.
Table 6: Symptoms and sports according to gender and knee arthritis grade.
All data are expressed as mean±standard deviation.
International Journal of Research in Orthopaedics | November-December 2024 | Vol 10 | Issue 6 Page 1367
Kshirsagar J et al. Int J Res Orthop. 2024 Nov;10(6):1364-1369
Data collection
Patient demographic, anthropometric and laboratory details were extracted from patient medical records. The details from the KOOS protocol that were filled out at the baseline visit were also extracted. Data from baseline were compared with data after a month and 90 days.
Statistical analysis
Categorical data are expressed as number (percentage) and continuous data are expressed as mean±standard deviation. Paired t test was used to determine the difference between baseline and follow-up at 90 days, p value ≤0.05 was considered as statistically significant. R version 3.4.1 software was used to analyses the data.
Demographics of patients
The mean age of the patients was 57.63±10.20 years. Females comprised 87.5% of the patients. Mean weight (day 1: 78.92±19.51 kg and day 90: 73.86±17.59 kg, p=0.00) and mean body mass index (day 1: 32.18±6.86 and day 90: 30.16±6.13, p=0.00) decreased at the 90-day follow-up. Similarly, systolic blood pressure (day 1: 124.50±10.76 mmHg and day 90: 114.69±13.17 mmHg, p=0.01) and diastolic blood pressure (day 1: 82.50±10.17 mmHg and day 90: 75.00±5.00 mmHg) decreased at the 90-day follow-up. The demographics of the patients is elaborated in Table 2.
Patient outcomes
The KOOS score (day 1: 20.31±11.18, after 1 month: 49.94±10.85, day 90: 71.31±5.89, p=0.00), pain (day 1: 25.44±14.03, after 1 month: 57.81±10.66, day 90: 80.63±5.78, p=0.00), symptoms (day 1: 30.69±14.59, after 1 month: 55.75±12.94, day 90: 83.00±6.04, p=0.00), sports (day 1: 2.81±6.84, after 1 month: 25.31±15.05, day 90: 39.69 ± 15.76, p=0.00), function/daily living (day 1: 31.25±16.69, after 1 month: 58.94±12.34, day 90: 78.81±7.98, p=0.00), and quality of life (day 1: 14.13±14.83, after 1 month: 52.00±10.78, after 1 month: 73.50±4.50, p=0.00) increased from baseline to the 90-day follow-up. The patient outcomes are detailed in Table 3. KOOS score, pain, average of function/daily living, quality of life, symptoms and sports according to knee arthritis grades for females and males is elaborated in Tables 4-6.
DISCUSSION
Osteoarthritis is the leading cause of chronic pain and disability in adults, imparting a substantial economic burden on both society and individuals. Knee osteoarthritis is the most common type with greater prevalence amongst women, as reflected in the current analysis. Its prevalence increases with an increase in body mass index-with higher prevalence among overweight and obese individuals.5 A large meta-analysis revealed obese or overweight
individuals have 2.1 times greater risk of knee osteoarthritis.6 Prevalence was also higher among rural inhabitants than urban inhabitants, indicative of higher prevalence among individuals with sedentary lifestyle.7 Thus, as the population ages and the prevalence of obesity increases, the clinical and economic burden rises. Ayurvedic treatment includes a judicious combination of external therapies (Bahya Chikitsa) and internal medication (Abhyantara Chikitsa). The Bahya Chikitsa can include Janu Basti, Abhyanga (massage), Jalaukavacharana (application of leech), Agnikarma (cautery), Basti (medicated enema), and others. Abhyantara Chikitsa can include internal medications in the form of Churna (powder of a single herb/ combination of herbs), Kashaya (decoction), Vati (pills), and others. However, there is a dearth of evidence on Ayurvedic treatment that have implemented Janu Basti in the treatment of knee osteoarthritis. A pilot study 8 of 6 patients explored the efficacy of Janu Basti in which Ksheerbala oil administered followed by local application of medicated steam.
Each session lasted for 40–50 mins daily and was adhered to for 21 days. During the 5-week follow-up, patients massaged the affected knee with Ksheerbala oil, followed by hot residence on their own. Significant improvement was observed-patients reported 100% relief from stiffness, 87.50% relief from pain, and 81.08% relief from physical function according to the Western Ontario and McMaster University Osteoarthritis (WOMAC) index. Another study Janu Basti was performed with 150 ml of Sahachara Taila in each knee joint for 30 mins daily for 14 days along with adherence to Adityapaka, Guggulu tablets days in 15 patients. The WOMAC index score decreased significantly from 49.60 to 29.60. Also, the Visual Analog Scale score decreased from 5.40 to 2.60. A few anecdotal reports also reveal symptomatic relief with Janu Basti.9,10
There are a few limitations of the case series. These include small sample size, retrospective study design, and short follow-up duration. Future larger prospective studies with longer follow-up duration are warranted to provide further insights.
CONCLUSION
Ayurvedic treatment is effective in improving the KOOS score and reducing the severity of arthritis in diagnosed osteoarthritis patients.
Funding: No funding sources Conflict of interest: None declared Ethical approval: Not required
REFERENCES
1. Singh A, Das S, Chopra A, Danda D, Paul BJ, March L, et al. Burden of osteoarthritis in India and its states, 1990-2019: findings from the Global Burden
International Journal of Research in Orthopaedics | November-December 2024 | Vol 10 | Issue 6 Page 1368
Kshirsagar J et al. Int J Res Orthop. 2024 Nov;10(6):1364-1369
of disease study 2019. Osteoarthritis Cartilage. 2022;30(8):1070-8. 2. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64(4):465-74 3. Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian Journal of Orthopaedics 2016;50:518-22. 4. Witt CM, Michalsen A, Roll S, Morandi A, Gupta S, Rosenberg M, et al. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee--study protocol for a randomized controlled trial. Trialss 2013;14:149. 5. Martin KR, Kuh D, Harris TB, Guralnik JM, Coggon D, Wills AK. Body mass index, occupational activity, and leisure-time physical activity: an exploration of risk factors and modifiers for knee osteoarthritis in the 1946 British birth cohort. BMC Musculoskelet Disord 2013;14:219. 6. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence
on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage 2015 Apr;23(4):507-15. 7. Yadav R, Verma AK, Uppal A, Chahar HS, Patel J, Pal CP. Prevalence of primary knee osteoarthritis in the urban and rural population in India. Ind J Rheumatol. 2022;17:239-43. 8. Mishra A, Shrivastava V. Managing an essential public health menace-Osteoarthritis of knee, through janu basti procedure of traditional Indian medicine - a pilot study. J Med Sci Res. 2020;8(4):150-9. 9. Singh AK, Rajoria K, Kumar A. A comparative clinical study of Janu Basti (medicated oil retention over knee) and Matra Basti (medicated oil enema) with Sahachara Taila along with Adityapaka Guggulu on osteoarthritis of knee joint. AYU 2023;44:96-102. 10. Reshma A, Bharti M, Sanjay G, Parul S. Role of janu basti and nadi-swedana in janu sandhigata vata (osteoarthritis of knee joint)-a single case study. J Nat Ayur Med. 2021;5(4):329.
Cite this article as: Kshirsagar J, Lakariya A, Khan S. Impact of ayurvedic panchakarma therapy on osteoarthritis. Int J Res Orthop 2024;10:1364-9.
International Journal of Research in Orthopaedics | November-December 2024 | Vol 10 | Issue 6 Page 1369